Fungal Keratitis - Signs & Management!


•Signs are usually more than symptoms.


RISK FACTORS:

OCULAR FACTORS

• Trauma (Vegetative Matter)

• Chronic corneal inflammation

• Contact lens wear

• Drugs (Corticosteroids)

• Corneal surgery


SYSTEMIC FACTORS

• Diabetes mellitus, HIV positive patients.


SLIT LAMP EXAMINATION:

•An epithelial defect the base of which is filled with soft, creamy exudates surrounded by a grayish area of stromal infiltration.

Specific features:

• Elevated areas.

• Hyphate (branching) ulcers.

• Irregular feathery margins.

• Dry rough texture.

• Satellite lesions.

• Immune ring, endothelial plaque, posterior corneal abscess (rare).


DIAGNOSIS:

• First, we scrape the ulcer from the ulcer edge and base.

• Corneal scraping is both diagnostic and therapeutic as it helps in the debridement and debulking of the organisms and enhances penetration of the anti-fungal drugs.

Send for:

• 10% KOH wet mount.

• Gram’s stain.

• Giemsa stain.

• Calcofluor White stain.

• Blood and chocolate agar.

• Sabouraud dextrose agar.


TREATMENT:

MEDICAL:

• Topical anti-fungals (usually Natamycin suspension) along with cycloplegics and anti-glaucoma drops (Amphotericin B depending on organism).


WHEN DO WE ADD SYSTEMIC ANTI-FUNGALS?

• Large ulcers close to or involving the sclera.

• Very deep ulcers (Occupying posterior 2/3rd of stroma).


Other treatment modalities:

• Intracameral Amphotericin B.

• Intrastromal Voriconazole.


SURGICAL: TPK.


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Image from Rajan Eye Care Hospital⁣

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